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EndoRepro 2 Exam 1 > Path Pt 2: Vulva, Vagina, Cervix > Flashcards

Path Pt 2: Vulva, Vagina, Cervix Flashcards

1
Q

smears of the inflammatory exudate from the active lesions show characteristic cytopathic changes consisting of multi-nucleated squamous cells containing eosinophilic to basophilic viral inclusions with a “ground glass” appearance

A

HSV

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2
Q

the infection is marked by acute inflammation of involved mucosal surfaces

  • smears of exudate disclose phagocytosed gram-negative diplococci within neutrophils
  • definitive dx requires culture or detection of gonococcal RNA or DNA
A

gonococcal

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3
Q

what happens when gonorrhea reaches the fallopian tubes?

A

acute suppurative salpingitis

  • tubal mucosa becomes congested and diffusely infiltrated by neutrophil, plasma cells, and lymphocytes, resulting in epithelial injuryand sloughing of the plicae
  • the tubal lumen fills with purulent exudate that may leak out of the fimbriated end
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4
Q

what happens if the gonorrhea infection spreads to the ovary?

A

salpingo-oophoritis

- collections of pus may accumulate within the ovary and tube (tubo-ovarian abscess) or tubal lumen (pyosalpinx)

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5
Q

what is chronic salpingitis?

A

scarring process that forms gland-like spaces and blind pouches
- the scarring of the tubal lumen and fimbriae may prevent the uptake and passage of oocytes, leading to infertility or ectopic pregnancy

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6
Q

this may develop as a consequence of the fusion of the fimbriae and the subsequent accumulation of the tubal secretions and tubal distention

A

hydropsalpink

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7
Q

compared to gonococcal infections, PID caused by what, tends to show less involvement of the mucosa and the tube lumen, and more inflammation within the deeper tissue layers
- these infections often spread throughout the wall to involve the serosa and the broad ligaments, pelvic structures and peritoneum

A

staph, strep and other puerperal invaders

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8
Q

what is a more frequent complication of strep or staph PID than of gonococcal infections?

A

bacteremia

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9
Q

presents either as a discrete white (hyperkeratotic) or a slightly raised, pigmented lesion

  • microscopically: characterized by epidermal thickening, nuclear atypia, increased mitoses, and lack of cellular maturation
  • analogous features to those seen in cervical squamous intraepithelial lesions
A

classic VIN

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10
Q

may be exophytic or indurated with central ulceration

  • on histo: basaloid carcinoma consists of nests and cords of small, tightly packed cells that lack maturation and resemble the basal layer of the normal epithelium
  • the tumor may have foci of central necrosis
A

VIN

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11
Q

what is characterized by exophytic, papillary architecture and prominent koilocytic atypia?

A

warty carcinoma

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12
Q

characterized by marked atypia of the basal layer of the squamous epithelium and normal-appearing differentiation of the more superficial layers

A

differentiated VIN

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13
Q

invasive what, that arise in differentiated VIN contain nests and tongues of malignant squamous epithelium with prominent central keratin pearls

A

keratinizing squamous cell carcinomas

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14
Q

distinctive intraepithelial proliferation of malignant cells

  • these cells are larger than surrounding keratinocytes and are seen singly or in small clusters within the epidermis
  • cells have pale cytoplasm containing mucopolysaccharide that stains with PAS, Alcian blue, or mucicarmine stains
A

Paget disease

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15
Q

what do Paget cells express?

A

cytokeratin 7
- they display apocrine, eccrine and keratinocyte differentiation and presumably arise from multi-potent cells found within the mammary-like gland ducts of the vulvar skin

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16
Q

approx 30% of vulvar cancers are caused by infection with high risk HPV’s, principally what strain?

A
  • *16**

- these cancers develop from an in situ lesion termed classic vulvar intraepithelial neoplasia (classic VIN)

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17
Q

most vulvar cancers are not related to what?

A

HPV
- they develop in a background of lichen sclerosis or squamous cell hyperplasia from the premalignant lesion called differentiated vulvar intraepithelial neoplasia (differentiated VIN)

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18
Q

the diagnosis of what, is based on identification of nuclear atypia characterized by nuclear enlargement, hyperchromasia (dark staining), coarse chromatin granules, and variation in nuclear size and shape

A

squamous intraepithelial lesions (SIL)

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19
Q

the nuclear changes in SIL are often accompanied by what?

A

cytoplasmic “halos”, which consist of perinuclear vacuoles

20
Q

what causes the cytoplasmic change in SIL?

A

HPV-encoded protein called E5 that localizes to the membranes of the endoplasmic reticulum

21
Q

what is koilocytic atypia?

A

nuclear alterations with an associated perinuclear halo

22
Q

the grading of SIL into low or high grade is based on expansion of what?

A

expansion of the immature cell layer from it’s normal, basal location

23
Q

what would lead to a lesion graded as LSIL?

A

if the immature squamous cells are confined to the lower one third of the epithelium

24
Q

what would lead to a lesion graded as HSIL?

A

if they expand to the upper two thirds of the epithelial thickness

25
Q

the highest viral loads are found where in LSIL?

A

in maturing keratinocytes in the upper half of the epithelium

26
Q

which proteins prevent cell cycle arrest?

A

HPV E6 and E7
- as a result, cells in the upper portion of the epithelium express markers of actively dividing cells, such as Ki-67, that are normally confined to the basal layer of the epithelium

27
Q

what leads to over expression of p16, a cyclin-dependent kinase inhibitor?

A

disturbed growth regulation

28
Q

both Ki-67 and p16 staining are highly correlated with what?

A

HPV infection and are useful for confirmation of the diagnosis in equivocal cases of SIL

29
Q

this disease may manifest as either fungating (exophytic) or infiltrative masses

A

invasive cervical carcinoma

30
Q

composed of nests and tongues of malignant squamous epithelium, either keratinizing or nonkeratinizing, which invade the underlying cervical stroma

A

squamous cell carcinoma of the cervix

31
Q

characterized by a proliferation of glandular epithelium composed of malignant endocervical cells with large, hyperchromatic nuclei and relatively mucin-depleted cytoplasm, resulting in a dark appearance of the glands, as compared to the normal endocervical epithelium

A

adenocarcinoma

32
Q

composed of intermixed malignant glandular and squamous epithelium

A

adenosquamous carcinoma

33
Q

the type of carcinoma has as appearance similar to small cell carcinoma of the lung, but differs in being positive for high risk HPVs

A

neuroendocrine carcinoma

34
Q

how does advanced cervical carcinoma spread?

A

by direct extension to contiguous tissues, including paracervical soft tissue, urinary bladder, ureters (resulting in hydronephrosis), rectum, and vagina

35
Q

where would you find distant cervical carcinoma metastases?

A

liver, lungs, bone marrow, and other organs

36
Q

what is the cervical cancer staging?

A

Stage 0 - CIS (CIN III, HSIL)

Stage I - carcinoma confined to the cervix

37
Q

what stage is considered preclinical carcinoma, that is diagnosed only by microscopy?

A

Stage Ia

38
Q

what stage of cervical carcinoma has stromal invasion no deeper than 3mm and no wider than 7mm (microinvasive carcinoma)

A

Ia1

39
Q

what stage of cervical carcinoma has a maximum depth of invasion of stroma deeper than 3mm and no deeper than 5mm taken from base of epithelium; horizontal invasion not more than 7mm

A

Ia2

40
Q

what stage of cervical carcinoma is histologically invasive carcinoma confined to the cervix and greater than stage Ia2?

A

Ib

41
Q

what stage of cervical carcinoma extends beyond the cervix, but not to the pelvic wall?
- carcinoma involves the vagina but not the lower third

A

II

42
Q

what stage of cervical carcinoma has extended to the pelvic wall?

  • on rectal exam there is no cancer-free space between the tumor and the pelvic wall
  • tumor involves the lower third of the vagina
A

III

43
Q

what stage of cervical carcinoma has extended beyond the true pelvis or has involved the mucosa of the bladder or rectum
- this stage also includes cancers with metastatic dissemination

A

IV

44
Q

productive HPV infections that usually regress spontaneously, but occasionally progress to high-grade squamous intraepithelial lesions (HSIL)

A

cervical low-grade squamous intraepithelial lesions (LSIL)

45
Q

characterized by progressive deregulation of the cell cycle and increasing cellular atypia
- may progress to invasive carcinoma

A

HSIL

46
Q

almost all cervical precursor lesions and cervical carcinomas are caused by high-risk HPV types, most commonly which?

A

16

EndoRepro 2 Exam 1 (25 decks)

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